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TIBC Blood Test: Normal Range, High & Low Levels

Written by Joe Cohen, BS | Last updated:
Medically reviewed by
Biljana Novkovic, PhD, Jonathan Ritter, PharmD, PhD (Pharmacology) | Written by Joe Cohen, BS | Last updated:

Total iron-binding capacity (TIBC) is an indicator of your body’s iron levels. Keep reading to learn more about high and low levels and what they mean for your health, as well as how to improve TIBC.

What is Total Iron-Binding Capacity (TIBC)

Total iron-binding capacity (TIBC) measures the total capacity of your blood to bind and transport iron. It is used to estimate the amount of iron stored in your body [1, 2].

TIBC is an indirect measure of transferrin, a protein that binds iron molecules and transports them in the bloodstream. Transferrin is produced in the liver and is the main iron-binding protein in the blood [3, 4].

TIBC is most often used to check for iron deficiency.

Because they measure the same thing TIBC and transferrin tests are redundant. It’s enough to measure one of them. TIBC is cheaper, but transferrin is preferable because it has a well established and more accurate range. TIBC may, however, be a better measure in populations that have high frequencies of transferrin genetic mutations [3].

Similarly, because they both measure iron stores in the body, if your ferritin levels are already available, TIBC levels may be redundant and unneeded when testing for iron deficiency [5].

Some laboratories also provide UIBC or unsaturated iron binding capacity, which is the number of transferrin sites not carrying iron [6].

TIBC Normal Range

The normal range of TIBC is between 250 – 450 μg/dL (micrograms per deciliter) which corresponds to 44.8 – 80.5 μmol/L (micromoles per liter).

Low TIBC Levels

Causes of Low TIBC

Causes shown below are commonly associated with low TIBC. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret your TIBC value, taking into account your medical history, symptoms, and other test results.

1) Excess Iron Levels (Iron Overload)

The most common cause of low TIBC is excess iron in the body [7].

Iron overload can happen due to poisoning, or in some hereditary disorders, such as hemochromatosis, thalassemia, or sickle cell anemia [7, 8].

However, not everyone with iron overload will have low TIBC. A lot of people with iron overload will have TIBC in the normal range [9].

2) Inflammation

Transferrin is a negative acute phase protein. This means that in inflammation, as the liver increases the production of inflammation-associated proteins (e.g. CRP, ferritin) it decreases the production of transferrin. As transferrin decreases, so does iron binding capacity and therefore TIBC [10, 11].

TIBC is decreased in people who have anemia of inflammation also known as anemia of chronic disease [12, 2]. This type of anemia is caused by inflammatory cytokines and associated with underlying conditions such as infections, inflammatory disease, autoimmune disease, and cancer [13].

3) Liver Disease

The liver helps keep iron levels in balance. During liver diseases and injury, more iron is absorbed in the gut, causing TIBC to decrease [14, 15].

Also, in liver disease, the liver can’t produce transferrin effectively, which decreases total iron-binding capacity [16].

4) Malnutrition

TIBC levels can be low in malnutrition [8].

5) Kidney Disease

Low TIBC can also be caused by kidney disease accompanied by protein loss (wasting) [11, 17].

6) Hemolysis

Abnormal destruction of red blood cells (hemolysis) [8].

Health Effects of Low TIBC

1) Is Associated With A Higher Heart Attack Risk

High iron levels are a risk factor for heart attack. In an observational study of over 2,000 people, low TIBC was associated with an increased risk for heart attacks over the next 8 year follow-up period. Each increase in TIBC of 1 μmol/L was associated with a 5% decrease in heart attack risk [18].

2) Is Associated With Higher Cancer Risk

In a study with over 41,000 people, lower TIBC was associated with a higher lung cancer risk over the 14-year follow-up [19].

In another study of 700+ people, lower TIBC was associated with a higher risk of colon cancer [20].

Increasing TIBC

The most important thing is to work with your doctor to find out what’s causing your low TIBC and to treat any underlying conditions. The additional lifestyle changes listed below are other things you may want to discuss with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!

The following are ways to increase TIBC by decreasing your iron levels when they are high. Other than that, you can only correct low TIBC levels by addressing and resolving the underlying condition/disease.

1) Exercise

If your iron is high, you can get more exercise. Regularly exercising can help prevent iron levels from becoming too high, as well as TIBC from decreasing [21, 22].

2) Diet

If you have high iron levels, you should avoid foods that are high in iron, such as red meat, fish, and poultry. You should also eat foods that reduce iron absorption, including fiber, phytic acid (from whole grains), and chili [23, 24, 25, 26].

Beverages such as coffee, cocoa, green tea, and herbal teas (chamomile, lime flower, penny flower, mint, and vervain) can also reduce iron absorption [27, 28, 29, 30, 31, 32, 33].

High TIBC

Causes of High TIBC

Causes shown below are commonly associated with high TIBC. Work with your doctor or another health care professional to get an accurate diagnosis. Your doctor will interpret your TIBC value, taking into account your medical history, symptoms, and other test results.

1) Iron Deficiency

TIBC increases during iron deficiency [7].

Iron deficiency can be due to dietary deficiency, bleeding (e.g. menstrual bleeding or ulcers), and gut disorders that decrease iron absorption (e.g. celiac disease) [7].

A study suggests that pregnant women may also commonly experience iron deficiency due to low dietary intake and higher demand, especially during the third trimester [34].

2) Polycythemia vera

Polycythemia vera is a disease in which the bone marrow makes too many red blood cells that use up a lot of iron. Polycythemia vera patients may have a functional iron deficiency, which can increase TIBC [8].

Health Risks of High TIBC

High TIBC is Associated with Celiac Disease Risk

Abnormal iron levels may play a role in celiac disease development. Alternatively, they may be an early sign of the disease, before it can be diagnosed by other means.

In a study of 852 people, a high TIBC level was associated with an increased risk of developing celiac disease. For each 10 μg/dL increase in TIBC, the risk of celiac disease increased by 4.6, 3.8, and 7.9% within 1, 1 – 3, and 3 – 5 years prior to diagnosis, respectively [35].

Decreasing TIBC

The most important thing is to work with your doctor to find out what’s causing your high TIBC and to treat any underlying conditions. The additional lifestyle changes listed below are other things you may want to discuss with your doctor. None of these strategies should ever be done in place of what your doctor recommends or prescribes!

1) Iron-rich Diet

Eating a diet high in iron can help prevent iron deficiency. Foods that contain a lot of iron include red meat, poultry, fish, tofu, tempeh, nuts, and seeds [23].

Avoid drinking coffee, cocoa, green and herbal teas with food, as these decrease iron absorption from food [27, 28, 29, 31, 32, 33].

Vitamin C helps increase iron absorption [36]. You can include more vitamin-C rich foods (e.g citrus fruits, sauerkraut) with your iron-rich meals.

However, keep in mind that iron deficiency can be caused by an underlying health issue, in which case it can’t be reversed by dietary modifications alone.

2) Supplements

If you have an iron deficiency, iron supplements will increase your iron levels. They are, however, associated with a lot of side effects. You also don’t want to overdo them, because iron overload increases oxidative stress in the body and has a lot of negative consequences. You may want to try and correct a mild efficiency through dietary intervention first [37, 38, 39].

For severe cases, your doctor may prescribe iron supplements or injections.

About the Author

Joe Cohen, BS

Joe Cohen, BS

Joe Cohen flipped the script on conventional and alternative medicine…and it worked. Growing up, he suffered from inflammation, brain fog, fatigue, digestive problems, insomnia, anxiety, and other issues that were poorly understood in traditional healthcare. Frustrated by the lack of good information and tools, Joe decided to embark on a learning journey to decode his DNA and track his biomarkers in search of better health. Through this personalized approach, he discovered his genetic weaknesses and was able to optimize his health 10X better than he ever thought was possible. Based on his own health success, he went on to found SelfDecode, the world’s first direct-to-consumer DNA analyzer & precision health tool that utilizes AI-driven polygenic risk scoring to produce accurate insights and health recommendations. Today, SelfDecode has helped over 100,000 people understand how to get healthier using their DNA and labs.
Joe is a thriving entrepreneur, with a mission to empower people to take advantage of the precision health revolution and uncover insights from their DNA and biomarkers so that we can all feel great all of the time.

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